Journal article

A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC).

  • Hawryluk GWJ Section of Neurosurgery, University of Manitoba, GB1, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
  • Aguilera S Almirante Nef Naval Hospital, Valparaiso University, Viña Del Mar, Chile.
  • Buki A Department of Neurosurgery, Medical School and Szentágothai Research Centre, Ifjúság Útja 20, Pécs, 7624, Hungary.
  • Bulger E Department of Surgery, Harborview Medical Center, University of Washington, 325 Ninth Ave, Seattle, WA, 98104-2499, USA.
  • Citerio G School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
  • Cooper DJ Intensive Care Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
  • Arrastia RD Department of Neurology, Penn Presbyterian Medical Center, University of Pennsylvania Perelman School of Medicine, 51 North 39th Street, Philadelphia, PA, 19104, USA.
  • Diringer M Department of Neurology, Washington University School of Medicine, St. Louis, USA.
  • Figaji A Division of Neurosurgery and Neuroscience Institute, Groote Schuur Hospital¸University of Cape Town, H53 Old Main Building, Main Road, Observatory, 7925, South Africa.
  • Gao G Department of Neurosurgery, Renji Hospital, Shanghai Institute of Head Trauma, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China.
  • Geocadin R Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA.
  • Ghajar J Department of Neurosurgery, Stanford Neuroscience Health Center, 213 Quarry Rd 4th Fl, MC 5958, Palo Alto, CA, 94304, USA.
  • Harris O Department of Neurosurgery, 300 Pasteur Drive, Room R205, Edward's Building, MC: 5327, Stanford, CA, 94305, USA.
  • Hoffer A Department of Neurological Surgery, School of Medicine, Case Western Reserve University, 11100 Euclid Avenue, 5042, Cleveland, OH, 44106, USA.
  • Hutchinson P Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge and Cambridge Biomedical Campus, Cambridge, CB20QQ, UK.
  • Joseph M Department of Neurological Sciences, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.
  • Kitagawa R Vivian L Smith Department of Neurosurgery, McGovern Medical School at UTHealth, 6400 Fannin St, Suite 2800, Houston, TX, 77030, USA.
  • Manley G Department of Neurosurgery, San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Ave., Bldg 1, Room 101, San Francisco, CA, 94110, USA.
  • Mayer S Department of Neurology, Henry Ford Hospital, 2799 W Grand Blvd, Neurology, K-11, Detroit, MI, 48202, USA.
  • Menon DK Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge and Addenbrooke's Hospital, Hills Road, Box 93, Cambridge, CB2 0QQ, UK.
  • Meyfroidt G Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Herestraat 49, Box 7003 63, 3000, Leuven, Belgium.
  • Michael DB Department of Neurosurgery, Beaumont Health, Michigan Head and Spine Institute, Oakland University William Beaumont School of Medicine, Southfield, MI, USA.
  • Oddo M Department of Intensive Care Medicine, Faculty of Biology and Medicine, CHUV-Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
  • Okonkwo D Department of Neurosurgery, University of Pittsburgh Medical Center Presbyterian, Suite B-400 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
  • Patel M Department of Surgery, Vanderbilt University Medical Center, 1211 21st Avenue South, 404 MAB, Nashville, TN, 37212, USA.
  • Robertson C Department of Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA.
  • Rosenfeld JV Department of Neurosurgery, Alfred Hospital, Melbourne, Australia.
  • Rubiano AM INUB/MEDITECH Research Group, Neurosciences Institute, El Bosque University, Bogotá, Colombia.
  • Sahuquillo J Department of Neurosurgery, University Hospital Vall d'Hebron, Barcelona, Spain.
  • Servadei F Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy.
  • Shutter L Department of Critical Care Medicine, Neurology and Neurosurgery, University of Pittsburgh Medical Center, 3550 Terrace St, Room 646, Pittsburgh, PA, 15261, USA.
  • Stein D Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Ave., Ward 3A, San Francisco, CA, 94110, USA.
  • Stocchetti N Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
  • Taccone FS Department of Intensive Care, Hospital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
  • Timmons S Department of Neurological Surgery, GH 5100 SNEU, Indianapolis, IN, 46202, USA.
  • Tsai E Suruchi Bhargava Chair in Spinal Cord and Brain Regeneration Research, The Ottawa Hospital, Department of Surgery, Division of Neurosurgery, University of Ottawa, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
  • Ullman JS Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, 300 Community Drive, 9 Tower, Manhasset, NY, USA.
  • Vespa P Gary L. Brinderson Family Chair in Neurocritical Care, UCLA School of Medicine, Los Angeles, USA.
  • Videtta W Intensive Care, Posadas Hospital, Buenos Aires, Argentina.
  • Wright DW Department of Emergency Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta, GA, 30303, USA.
  • Zammit C Department of Emergency Medicine, University of Rochester Medical Center, 265 Crittenden Blvd, Suite 2100, Box 655C, Rochester, NY, 14642, USA.
  • Chesnut RM Department of Neurological Surgery, University of Washington, Mailstop 359766, 325 Ninth Ave, Seattle, WA, 98104-2499, USA. chesnutr@uw.edu.
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  • 2019-10-30
Published in:
  • Intensive care medicine. - 2019
English BACKGROUND
Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation's sTBI Management Guidelines, as they were not evidence-based.


METHODS
We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists' decision tendencies were the focus of recommendations.


RESULTS
We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination.


CONCLUSIONS
Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.
Language
  • English
Open access status
hybrid
Identifiers
Persistent URL
https://folia.unifr.ch/global/documents/172930
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